AB0759 Efficacy of secukinumab in patients with non-radiographic axial spondyloarthritis: analysis by symptom duration and age
Authors: A. Deodhar, D. Poddubnyy, R. Blanco, S. Hall, M. Magrey, E. Quebe-Fehling, R. Calheiros, P. Pertel, H. Marzo-Ortega
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients (pts) with axial spondyloarthritis (axSpA) often experience delayed diagnosis, which can lead to treatment delay 1 . However, earlier diagnosis and treatment of axSpA pts can lead to a greater clinical response 2 . Secukinumab (SEC) 150 mg has demonstrated sustained improvement in signs and symptoms over 2 years in non-radiographic (nr)-axSpA pts 3 . Objectives To assess the efficacy of SEC in pts with nr-axSpA [tumour necrosis factor (TNF) naïve] by subgroups of younger versus (vs) older pts and early vs late symptom duration of back pain. Methods PREVENT ( NCT02696031 ) is a phase 3, randomised study in pts with nr-axSpA and detailed study design is reported previously4. In this post hoc analysis, efficacy outcomes including Assessment of SpondyloArthritis international Society 40 (ASAS40), ASAS partial remission (ASAS PR), Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) inactive disease (ID) and low disease activity (LDA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the proportion of pts meeting the minimal clinically important difference criteria for total back pain (improvement of ≥50%) were assessed in the TNF naïve population. Age categories included 4 approximately equally distributed age groups (18 to 33, 34 to 42, 43 to 51 and ≥52 years). The categories for time since onset of back pain as a surrogate of disease symptoms and sign, was based on patients’ distribution and the hypothesis that patients with shorter disease duration will present better results (≤2, &gt;2 to 5, &gt;5 to 10 and &gt;10 years). Missing responses were imputed as non-response up to Week (Wk) 16 and reported as observed at Wks 52 and 104. Data is presented here for categories 18-33 vs ≥52 years and patients with symptom duration ≤2 vs &gt;10 years. Results At Wk 104, greater improvements in ASAS40 scores were reported in younger (18-33 years) vs older age categories (&gt;52 years) treated with SEC and also in patients with shorter disease duration (≤2 years) when compared to long term disease (Figure 1 and Table 1). Table 1. Efficacy responses with SEC up to Week 104 based on age and symptom duration Age 18-33 years Age &gt;52 years ≤2 years of back pain &gt;10 years of back pain SEC 150 mg LD (N=61) SEC 150 mg NL (N=59) PBO (N=61) SEC 150 mg LD (N=25) SEC 150 mg NL (N=33) PBO (N=28) SEC 150mg LD (N=51) SEC 150 mg NL (N=33) PBO (N=47) SEC 150 mg LD (N=50) SEC 150 mg NL (N=46) PBO (N=49) ASDAS-CRP ID and LDA 50.8* 55.9* 34.4* 36.0* 39.4* 21.4* 51.0* 48.5* 40.4* 44.0* 30.4* 26.5* 77.4 # 81.1 # 72.2 # 45.8 # 46.7 # 33.3 # 77.3 # 60.0 # 77.3 # 53.3 # 48.7 # 37.2 # 71.7 † 70.2 † 77.6 † 50.0 † 57.1 † 60.9 † 74.4 † 69.2 † 82.1 † 55.3 † 53.3 † 53.8 † BASDAI 50 45.9* 47.5* 27.9* 28.0* 36.4* 17.9* 45.1* 51.5* 29.8* 34.0* 23.9* 20.4* 77.8 # 71.7 # 72.2 # 37.5 # 53.3 # 37.0 # 75.6 # 60.0 # 75.0 # 46.7 # 46.2 # 43.2 # 73.5 † 72.3 † 77.6 † 47.6 † 60.9 † 52.2 † 78.0 † 65.4 † 76.9 † 53.8 † 53.1 † 51.3 † ASAS PR 29.5* 32.2* 8.2* 12.0* 12.1* 7.1* 27.5* 24.2* 8.5* 18.0* 10.9* 12.2* 41.5 # 50.9 # 38.9 # 12.5 # 20.0 # 22.2 # 45.5 # 40.0 # 38.6 # 22.2 # 23.1 # 20.5 # 46.9 † 44.7 † 59.2 † 23.8 † 31.8 † 21.7 † 56.1 † 34.6 † 46.2 † 25.6 † 25.8 † 23.1 † Total back pain 50.8* 50.8* 27.9* 24.0* 30.3* 32.1* 51.0* 48.5* 36.2* 32.0* 23.9* 32.7* 74.1 # 75.5 # 72.2 # 58.3 # 46.7 # 44.4 # 73.3 # 63.3 # 72.7 # 53.3 # 48.7 # 47.7 # 71.4 † 68.1 † 79.6 † 61.9 † 52.2 † 52.2 † 75.6 † 69.2 † 74.4 † 61.5 † 50.0 † 59.0 † Data is presented as % of responders. Symbols are used to denote the Weeks. *Week 16; # Week 52; † Week 104 . All patients received open-label SEC 150 mg treatment after Week 52 up to Week 104 . ASDAS-CRP ID and LDA (ASDAS-CRP &lt;2.1); Total back pain improvement ≥50% . LD, loading dose; NL, without loading; PBO, placebo Conclusion Efficacy responses were numerically higher with SEC in patients with nr-axSpA with shorter symptom duration and in younger age. These data suggest that earlier treatment improves patient outcomes in nr-axSpA. References [1]Lapane KL, et al. BMC Fam Pract . 2021;22(1):251 [2]Poddubnyy D, Sieper J. Curr Rheumatol Rep . 2020;22(9):47 [3]Poddubnyy D, et al. Ann Rheum Dis . 2021;80 (suppl1):707 [4]Deodhar A et al. Arthritis Rheumatol . 2021;73(1):110-120 Disclosure of Interests Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Glaxo Smith &amp; Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, Glaxo Smith &amp; Kline, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, UCB, Roche, Consultant of: AbbVie, BMS, Eli Lilly, MSD, Novartis, Pfizer, UCB, Roche, Grant/research support from: AbbVie, MSD, Novartis, Pfizer, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma, MSD and Lilly, Consultant of: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma and MSD, Grant/research support from: AbbVie, MSD, and Roche, Stephen Hall Speakers bureau: Novartis, Merck, Janssen, Pfizer, Eli Lilly, and UCB, Consultant of: Novartis, Merck, Janssen, Pfizer, Eli Lilly, and UCB, Grant/research support from: AbbVie, UCB, Janssen, and Merck, Marina Magrey Consultant of: Eli Lily, Novartis, Grant/research support from: AbbVie, UCB and Amgen, Erhard Quebe-Fehling Shareholder of: Shareholder of Novartis, Employee of: Novartis, Renato Calheiros Shareholder of: Shareholder of Novartis, Employee of: Novartis, Patricia Pertel Shareholder of: Shareholder of Novartis, Employee of: Novartis, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Moonlake, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen, Novartis and UCB